Provider Demographics
NPI:1427616135
Name:MARQUEZ, ALFREDO T
Entity type:Individual
Prefix:
First Name:ALFREDO
Middle Name:T
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 NW 114TH AVE UNIT 437
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4580
Mailing Address - Country:US
Mailing Address - Phone:305-492-5746
Mailing Address - Fax:
Practice Address - Street 1:6440 NW 114TH AVE UNIT 437
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4580
Practice Address - Country:US
Practice Address - Phone:305-492-5746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-61803106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician